Provider Resources

Patients with chronic pain deserve safe and effective pain management. Opioids can be part of that pain management plan, but they have serious risks, including overdose and addiction:

• Treating Pain: What Alaskans Should Know

The CDC Guideline for Prescribing Opioids for Chronic Pain promotes the use of non-opioid therapy for chronic pain outside of active cancer, palliative care, and end-of-life care; the use of the lowest possible effective dosage to reduce risks; and cautious prescribing and close monitoring of patients.

The Alaska State Medical Board-issued Guidelines Regarding Prescribing Controlled Substances.

For procedure-specific opioid prescribing recommendations, consult the Michigan OPEN post-operative guidelines.

Dentists are encouraged to review the Alaska Dental Society's Opioid & Non-opioid Alternative Prescribing Guideline.

The CDC has produced multiple tools to help primary care providers follow guidelines, including:

• Fact sheet: Guideline for Prescribing Opioids for Chronic Pain
• Checklist for prescribing opioids for chronic pain
• Assessing Benefits and Harms

A free weekly service for community providers intended to increase knowledge and confidence in chronic pain management, and to present difficult chronic pain cases for consultation. It includes recommendations from a network of five interprofessional specialists with expertise in the management of challenging chronic pain problems. The goal is to increase the knowledge and skills of community practice providers who treat patients with chronic pain. CMEs are available.

This hotline will support consultation on treating patients with complex pain medication regimens. UWMedicine pain pharmacists, and if appropriate, physicians, are available to support your questions.

Hotline phone number: 1-844-520-PAIN (7246)
Hours of Operation: Monday through Friday, 7:30am to 3:30pm (excluding holidays)
Cost: Free 

The Health Resources & Services Administration (HRSA) provides a tapering guideline for appropriate dosage reduction or discontinuation of long-term opioid analgesics. https://www.hhs.gov/system/files/Dosage_Reduction_Discontinuation.pdf

Use the Alaska Prescription Drug Monitoring Program. The Alaska Prescription Drug Monitoring Program (AKPDMP) is a patient safety tool, used to make prescribing decisions based on patient’s histories. This program is designed to improve patient care and foster the goal of reducing misuse and diversion of controlled substances. AKPDMP is used to monitor Schedule II -V controlled substances dispensed in Alaska.

Learn more about legislation related the program, tutorials on how to use it, and more, at the PDMP page sponsored by the Department of Commerce, Community and Economic Development.

• Consider using the Alaska Acute Pain Treatment Discussion Tool to discuss the management of acute pain with your patient. Learn more about this tool and how to use it in this letter to prescribers.
• People of every age, gender and social status have become addicted to opioids. It’s important to talk about the risk factors with everyone.
• When making the decision to prescribe opioids rather than using other therapy for pain, ask about previous drug use, history of substance abuse disorder or overdose, benzodiazepine use, sleep-disordered breathing, and other co-existing mental health conditions such as depression, anxiety and PTSI.
• Always focus on functional goals and improvement, and set the criteria for stopping or continuing use. Talk to patients about how opioid therapy will be discontinued if its benefits do not outweigh the risks.
• Go low dose by using the lowest dosage on the product’s labeling. Match the duration of use with the next scheduled reassessment.
• Educate your patient about safe use, storage and proper disposal of opioids.

Set an initial reassessment within one to four weeks, and monitor the patient for signs of misuse of opioids at every assessment.

• Only continue opioid treatment after confirming clinically meaningful improvements
• Evaluate risk of harm or misuse
• If risk is elevated, taper dose
• Seek opioid misuse treatment for the patient as needed

Resource from the Substance Abuse and Mental Health Services Administration can provide advice on treatment options:

• Advisory: Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder https://library.samhsa.gov/product/advisory-sublingual-and-transmucosal-buprenorphine-opioid-use-disorder-review-and-update/sma16-4938
• Federal Guidelines for Opioid Treatment Programs https://library.samhsa.gov/sites/default/files/guidelines-opioid-treatment-pep15-fedguideotp.pdf

Learn how co-prescribing naloxone can help prevent overdose. Naloxone is also available through Project Hope.

The Division of Behavioral Health maintains a page about treatment options in Alaska.

The Substance Abuse and Mental Health Services Administration’s MAT webpage offers more information on medication-assisted treatment, like this Medication-Assisted Treatment of Opioid Use Disorder Pocket Guide.

The Voluntary Nonopioid Directive (VNOD) is a form for individuals who wish to decline future treatment with opioids. Health care providers and patients complete and sign this form together. The VNOD aims to prevent providers from inadvertently offering certain controlled substances to those who could be adversely affected. It also empowers patients to proactively inform their provider that they do not wish to receive opioids for any reason. Access the Voluntary Nonopioid Directive and additional guidance.

Clinical Support System for Medication Assisted Treatment (PCSS-MAT). This training is designed to increase the knowledge base and clinical proficiency of prescribers and providers from diverse multi-disciplinary healthcare backgrounds.

• Patient/Provider Discussion Brochure: Acute Pain Treatment and Opioids (5.5"x8.5")
• Patient/Provider Discussion Handouts (8.5"x11):
  
  • Acute Pain Treatment and Opioids, English
  • Acute Pain Treatment and Opioids, Korean
  • Acute Pain Treatment and Opioids, Tagalog
  • Acute Pain Treatment and Opioids, Yup'ik
• Helping Babies with Neonatal Abstinence Syndrome (booklet)